Ricerc@Sapienza

Introduction: In case of malignant cerebral infarction and progressive neurological
worsening, decompressive craniectomy is the surgical option that is recommended
when medical therapies fail. The occurrence of an intracerebral hemorrhage after
reconstruction of the bone defect is extremely rare. This is an extremely rare
complication, with only four cases reported thus far in the literature.
Case Report: A 54-year-old male suffered a malignant cerebral infarction and
progressive neurological worsening requiring decompressive hemicraniectomy. Three
months later, an autologous cranioplasty was performed. Postoperatively, the patient
experienced a generalized epileptic seizure and a hemorrhage in the left cerebellar
hemisphere on control CT scan. After surgical removal the patient did not improve, and
CT revealed the occurrence of further cerebellar, mesencephalic, and intraventricular
hemorrhages. Systemic inflammatory response syndrome was suspected, but death
occurred 72 hours after cranioplasty.
Conclusions: The reperfusion-hyperperfusion mechanism after cranioplasty might favor
intracerebral hemorrhages limited to the ischemic tissue, which is unable to support the
cerebral blood perfusion pressure. When diffuse atypical hemorrhages far from the
surgical site occur after cranioplasty, a systemic inflammatory response syndrome is
supposed.